Trimix (drug) explained

Trimix is a prescription combination drug containing alprostadil, papaverine, and phentolamine. It is used to treat erectile dysfunction.[1] [2] [3]

Medical use

Available forms

Trimix is available in several different formulations, including a gel that can be used topically, a gel that can be administered into the urethra, and an injectable form that is administered via intracavernosal injection (an injection at either side, not the base, of the penis).[2] [4] [5] [6]

Adverse effects

Adverse effects from injecting Trimix may include pain, fibrosis, hematoma, and priapism (a prolonged erection of the penis).[3]

Pharmacology

Trimix is a combination of three drugs: alprostadil, papaverine, and phentolamine. These medications work in combination to increase blood flow to the penis, resulting in an erection.[1] [2] [3] Alprostadil is a prostaglandin vasodilator that allows more blood to flow into the area by relaxing the smooth muscle in the blood vessels of the penis.[3] [7] Papaverine is a smooth muscle relaxant that acts by increasing blood flow to the penis.[3] [8] Phentolamine is an alpha blocker that relaxes blood vessel muscles, allowing more blood to flow to the penis.[3] [9]

Society and culture

Availability

While the active drugs in Trimix have all been individually approved by the U.S. Food and Drug Administration (FDA), Trimix as a combination drug has not been approved by the FDA and is only available from compounding pharmacies.[1] [3] [10] Trimix is typically prepared by the compounding pharmacy in a sterile environment and then frozen.[11] The compound is stable for up to six months while stored frozen and for one month if stored refrigerated beginning at the time of manufacture.[12]

External links

Notes and References

  1. Elena BW, Zachary M, Haritha P, Graham BA, Wayne HJ . Current status of intracavernosal injection therapy in erectile dysfunction . Expert Opinion on Pharmacotherapy . 24 . 8 . 925–933 . June 2023 . 37078428 . 10.1080/14656566.2023.2204189 . 258238107 .
  2. Marmar JL, Harkins TJ, Riordan J . Studies with Trimix gel in men who failed phosphodiesterase inhibitors . . 179 . 4S . May 2008 . 0022-5347 . 10.1016/s0022-5347(08)61264-1 . 431 .
  3. Duncan C, Omran GJ, Teh J, Davis NF, Bolton DM, Lawrentschuk N . Erectile dysfunction: a global review of intracavernosal injectables . World Journal of Urology . 37 . 6 . 1007–1014 . June 2019 . 30895359 . 10.1007/s00345-019-02727-5 . 84185652 .
  4. Seyam R, Mohamed K, Akhras AA, Rashwan H . A prospective randomized study to optimize the dosage of trimix ingredients and compare its efficacy and safety with prostaglandin E1 . International Journal of Impotence Research . 17 . 4 . 346–353 . 2005 . 15772683 . 10.1038/sj.ijir.3901313 . free .
  5. Kim SC, Chang IH, Jeon HJ . Preference for oral sildenafil or intracavernosal injection in patients with erectile dysfunction already using intracavernosal injection for > 1 year . BJU International . 92 . 3 . 277–280 . August 2003 . 12887483 . 10.1046/j.1464-410X.2003.04324.x . 41078747 .
  6. Israilov S, Baniel J, Shmueli J, Niv E, Engelstein D, Segenreich E, Livne PM . Treatment program for erectile dysfunction in patients with cardiovascular diseases . The American Journal of Cardiology . 93 . 6 . 689–693 . March 2004 . 15019870 . 10.1016/j.amjcard.2003.11.049 .
  7. Book: Jain A, Iqbal O . Alprostadil . StatPearls . Treasure Island (FL) . StatPearls Publishing . 18 July 2022 . 31194374 . https://www.ncbi.nlm.nih.gov/books/NBK542217/ . 24 April 2023.
  8. Kim ED, el-Rashidy R, McVary KT . Papaverine topical gel for treatment of erectile dysfunction . The Journal of Urology . 153 . 2 . 361–365 . February 1995 . 7815584 . 10.1097/00005392-199502000-00019 .
  9. Bella AJ, Brock GB . Intracavernous pharmacotherapy for erectile dysfunction . Endocrine . 23 . 2–3 . 149–155 . 2004 . 15146094 . 10.1385/ENDO:23:2-3:149 . The vasoactive potential of phentolamine was discovered in 1978, with early animal studies suggesting effective blockade of the epinephrine pressor response and a smaller sympatholytic effect (63). An alpha-adrenergic antagonist with equal affinity for α1 and α2 receptors, monotherapy with phentolamine has been disappointing. It is hypothesized that although intracavernous injection of phentolamine increases corporal blood flow, a concurrent increase in norepinephrine prevent sinusoidal relaxation. . 13056029 .
  10. Web site: Billingsley A . What to Know About Trimix Injections for Erectile Dysfunction . GoodRx Health . 26 April 2023 . 28 January 2022.
  11. Web site: Alprostadil / Papaverine / Phentolamine 20mcg-30mg-1mg/ml Injection Solution (Tri-Mix) Formulas My Dashboard . Bayview Pharmacy . 2023-01-11 .
  12. Trissel LA, Zhang Y . Long-term stability of trimix: a three-drug injection used to treat erectile dysfunction . International Journal of Pharmaceutical Compounding . 8 . 3 . 231–235 . 2004 . 23924676 .

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